Our work matters. We help people get the medicine they need to feel better and live well.  We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Client Audit Specialist, Sr. - RemoteJob Description

As a member of the Client Audit Management (CAM) team, the Client Audit Specialist, Sr is accountable for managing regulatory and/or client-initiated audits. This role maintains a thorough understanding of the purpose and protocols of various audit types and serves as a CAM process/subject matter expert supporting the navigation of the end-to-end audit process. The Advisor seeks and obtains additional expertise as indicated from respective Compliance and operational subject matter experts to meet the applicable regulatory, client, and/or functional audit expectations and provides mentorship, training and support to the Client Audit Specialists and/or Analysts. This role may also provide strategic advice and consultation regarding audit management to CAM and business partners.

Responsibilities

Serve as internal expert for various regulatory and/or client-initiated audit types, processes and protocols; assess audit process documentation and data files and identify and consult on department enhancement initiatives to ensure accurate and thorough training and procedural materials are available and maintained; serve as trainer and mentor for the Client Audit Specialists  and AnalystsReview and interpret audit requests to determine scope, impacted business areas and stakeholders, and evidence necessary to fulfill and manage the audit request; support CAM leadership in determining audit assignments, evaluating complexity, audit status and team capacityDevelop and maintain key internal and external relationships to effectively provide audit management consultation regarding the streamlining of work activity, creation of efficiencies, and promoting consistent, timely and accurate completion, reporting, or submission of audit deliverablesMonitor audit progress and proactively identify and mitigate risks (including performance guarantee implications) to audit completion; appropriately escalate to department leadership or operational stakeholders and provide remediation recommendations to prevent delays or future findingsEnsure stakeholders have a thorough understanding of their audit-related responsibilities, are accountable to producing deliverables accurately and on time, and are informed of relevant audit status updates or changesEnsure thorough audit records are developed and maintained, with emphasis on accuracy, relevance, and timeliness; prepare necessary documentation for audit activities including deliverables, reports, findings and recommendations; provide clear and concise audit result communications to internal and external stakeholders and department leadership as necessary; serve as peer reviewer and provide quality checks for CAM staffDemonstrate high-level project management and organization capabilities by effectively communicating and leading audit strategy, deliverables, requirements, milestones and accountability, from the point of audit intake through the entire auditConduct operational audit management training to support audit readiness throughout the organization and support CAM onboarding and staff developmentOther duties as assigned

Minimum Qualifications

Bachelor’s degree in Business, Health Care Services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required5 years of relevant  work experience in compliance, operations, or external audit within a regulated environmentMust be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

Strong verbal and written communication, and presentation skills; ability to effectively distill complex information into clear and compelling presentations and leadership briefingsExcellent interpersonal skills, with the ability to effectively facilitate meetings, resolve conflict, build consensus, establish rapport and collaborate effectively across departments, internally and externally, and at all levels within an organization; ability to confidently represent the business and interact with external entitiesDemonstrated critical thinking and analysis skills, with proven ability to navigate ambiguous, complex and challenging situations while maintaining professionalism, tact, and empathyStrong organization and prioritization skills, strong attention to detail, and the ability to simultaneously manage multiple, complex projects, under pressure and strict timeframes, without compromising qualityAgility and adaptability to change and navigate in a dynamic, fast-paced, intense, and matrix environmentAbility to use independent judgment and critical decision making in the analysis of audit processes and evidenceAdvanced proficiency in Microsoft Office Suite (Word, Excel, Power Point, Visio and Access)

Preferred Qualifications

Health insurance/PBM operations and/or contract audit experienceExperience with regulatory compliance for Medicare/Medicaid/Commercial or ACA drug benefitProject management experienceCertification or licensure in a related area of expertise (e.g., Pharmacy Technician, CCEP or HCCA certification)

Minimum Physical Job Requirements

Minimal travel may be requiredAbility to work a flexible schedule outside of Prime’s core business hours to occasionally accommodate different time zones and during critical client auditsConstantly required to sit, use hands to handle or feel, talk and hearFrequently required to reach with hands and armsOccasionally required to stand, walk and stoop, kneel, and crouchOccasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 poundsSpecific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

Reports to a Manager in the Compliance department

Potential pay for this position ranges from $74,000.00 - $118,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law. 

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.